Healthcare Provider Details

I. General information

NPI: 1538850912
Provider Name (Legal Business Name): ABDULRAHMAN EBA'A HAMDI ALHANBALI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2023
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date: 12/21/2023
Reactivation Date: 01/16/2024

III. Provider practice location address

1 CHILDRENS WAY
LITTLE ROCK AR
72202-3500
US

IV. Provider business mailing address

1 CHILDRENS WAY
LITTLE ROCK AR
72202-3500
US

V. Phone/Fax

Practice location:
  • Phone: 501-364-2021
  • Fax:
Mailing address:
  • Phone: 501-364-2012
  • Fax: 501-364-3667

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberBP10084513
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: